Ectopic Pregnancy

An ectopic pregnancy, also occasionally referred to as a tubal pregnancy, is basically a pregnancy that develops outside the uterus. It occurs in at least 0.5-1% of pregnancies.

This form of pregnancy arises when your fertilised egg doesn't implant in the uterus, but implants instead in one of the Fallopian Tubes (in 99% of cases), occasionally in one of the ovaries and, rarely, in the abdominal cavity or cervix.

In normal circumstances, a fertilised egg travels down to the uterus for implantation through the Fallopian tube. If, however, your Fallopian tube is damaged or abnormal in any way, perhaps due to infection (mostly chlamydia), endometriosis or previous surgery, then your egg can become blocked in the tube.

An ectopic pregnancy may also occur in cases where contraception with an intrauterine device or coil has failed, or following a sterilisation operation, in particular where the Fallopian tube has been cut. An ectopic pregnancy can also occur in women who have none of these risk factors.

What are the implications?

If you have an ectopic pregnancy, damage or rupture of the surrounding tissue can result as your embryo grows, leading to serious bleeding. In such cases, the pregnancy cannot be sustained and the embryo and placental tissue will need to be removed.

An ectopic pregnancy is treated as a serious condition, which may need emergency treatment since, if ignored, it can be potentially fatal because of internal bleeding.

What are the signs of an ectopic pregnancy?

Some women who have an ectopic pregnancy may not even know that they're pregnant, and consequently may mistake the bleeding associated with the condition for a period. Others, however, may notice certain warning signs soon after a missed period.

Warning signs of a sub-acute form of an ectopic pregnancy include severe cramp-type abdominal pain, usually restricted to one side, with or without spotting or vaginal bleeding (which may be mistaken for a period) and possibly the presence of a brown discharge. You may also feel faint, or faint, and experience some shoulder pain on the same side as the abdominal pain. With the acute form, because of rupture or internal bleeding, you may also have symptoms of shock, which include pale skin, sweating, weakness, dizziness and a weak pulse, as well as declining blood pressure.

The majority of ectopic pregnancies manifest during the first 1-2 months of pregnancy. A pregnancy test and an ultrasound scan are used to detect an ectopic pregnancy, and this is usually confirmed using laparoscopy. Blood tests to measure pregnancy hormone levels can also be helpful.

What can be done?

If you've had a previous ectopic pregnancy, let your healthcare professional know since he/she may want to arrange an ultrasound scan to see if the problem has recurred.

If an ectopic pregnancy is identified at an early stage, then you may be given an injection of a drug to stop the growth of the ectopic, and allow it instead to reabsorb. In more severe cases you may need to have surgery, which is often 'minimally invasive' using telescopic equipment to remove the embryo, placenta and any damaged tissue. In other cases, conventional surgery will be needed to repair the damage and, if the Fallopian tube is affected but cannot be repaired, then it will be removed. Some women who have profuse bleeding may also need a blood transfusion.

Many women who have had an ectopic pregnancy can get pregnant again and have a normal pregnancy, even if a Fallopian tube is removed. However, the chances of conception are reduced, and the chances of a further ectopic are increased.

For further information and expert advice on pregnancy, please visit Ireland's largest and most trusted parenting and pregnancy website, http://www.eumom.ie.